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For an extended period, jolting along the soggy dirt track to the clinic, 18-year-old Makka Ibraheem Mohammed held on tight to her seat and concentrated on stopping herself throwing up. She was in childbirth, in severe suffering after her uterus ruptured, but was now being shaken violently in the ambulance that jumped along the uneven terrain of the road through the Chadian desert.

Most of the hundreds of thousands of Sudanese displaced persons who escaped to Chad since 2023, living hand to mouth in this inhospitable environment, are women. They reside in isolated camps in the desert with scarce resources, little employment and with healthcare often a dangerously far away.

The medical center Mohammed needed was in Metche, another refugee camp more than 120 minutes away.

“I kept getting infections during my term and I had to go the medical tent seven times – when I was there, the pregnancy started. But I could not give birth naturally because my womb had given way,” says Mohammed. “I had to wait two hours for the ambulance but all I can think of the pain; it was so bad I became confused.”

Her parent, Ashe Khamis Abdullah, 40, was terrified she would suffer the death of her offspring and descendant. But Mohammed was hurried into surgery when she got to the hospital and an critical surgical delivery rescued her and her son, Muwais.

Chad already had the world’s second most severe maternal mortality rate before the recent arrival of refugees, but the conditions endured by the Sudanese place additional women in risk.

At the hospital, where they have delivered 824 babies in mostly emergency conditions this year, the doctors are able to save many, but it is what affects the women who are not able to reach the hospital that alarms the professionals.

In the couple of years since the civil war in Sudan began, 86% of the people who reached and stayed in Chad are females and minors. In total, about 1.2 million Sudanese are being accommodated in the eastern region of the country, a large number of whom ran from the earlier war in Darfur.

Chad has hosted the bulk of the 4.1 million people who have run from the war in Sudan; the remainder moved to South Sudan, Egypt and Ethiopia. A total of almost twelve million Sudanese have been uprooted from their homes.

Many men have not left to be near homes and land; some were slain, captured or made to join the conflict. Those of adult age rapidly leave from Chad’s isolated encampments to seek employment in the capital, N’Djamena, or beyond, in nearby Libya.

It implies women are left alone, without the means to provide for the dependents left in their care. To prevent congestion near the border, the Chadian government has relocated people to less crowded encampments such as Metche with typical numbers of about a large community, but in remote areas with no services and scarce prospects.

Metche has a hospital built by a medical aid organization, which began as a few tents but has developed to contain an operating theatre, but not much more. There is unemployment, families must walk hours to find fuel, and each person must subsist with about a small amount of water a day – far below the advised quantity.

This seclusion means hospitals are admitting women with issues in their pregnancy at a critical stage. There is only a one medical transport to serve the area between the Metche hospital and the health post near the camp at Alacha, where Mohammed is one of nearly 50,000 refugees. The medical team has seen cases where women in severe suffering have had to wait an entire night for the ambulance to arrive.

Imagine being in the final trimester, in childbirth, and travelling hours on a donkey-drawn vehicle to get to a hospital

As well as being rough, the path goes through valleys that become inundated during the rainy season, completely preventing travel.

A surgeon at the hospital in Metche said each patient she treats is an crisis, with some women having to make arduous trips to the hospital by on foot or on a pack animal.

“Imagine being in the late stages of pregnancy, in labour, and journeying for an extended time on a animal-drawn vehicle to get to a hospital. The biggest factor is the delay but having to come in these conditions also has an impact on the birth,” says the surgeon.

Malnutrition, which is on the rise, also elevates the likelihood of issues in pregnancy, including the uterine splits that medical staff see regularly.

Mohammed has stayed at the medical facility in the 60 days since her caesarean. Experiencing malnutrition, she contracted an illness, while her son has been carefully monitored. The parent has journeyed to other towns in look for employment, so Mohammed is entirely leaning on her mother.

The undernourishment unit has expanded to six tents and has cases exceeding capacity into other sections. Children rest beneath mosquito nets in extreme warmth in almost complete silence as medical staff work, creating remedies and measuring kids on a instrument created using a bucket and rope.

In less severe situations children get packets of PlumpyNut, the uniquely designed peanut paste, but the most severe instances need a consistent supply of nutrient-rich liquid. Mohammed’s baby is given his nourishment through a medical device.

Suhayba Abdullah Abubakar’s baby boy, Sufian Sulaiman, is being given nutrition by a nose tube. The infant has been unwell for the past year but Abubakar was only provided with painkillers without any medical assessment, until she made the trip from Alacha to Metche.

“Every day, I see more children arriving in this structure,” she says. “The meals we consume is low-quality, there’s not enough to eat and it’s not nutritious.

“If we were at home, we could’ve adjusted our lives. You can go and cultivate plants, you can get a job, but here we’re relying on what we’re given.”

And what they are given is a small amount of cereal, vegetable oil and salt, handed out every 60 days. Such a basic diet offers little sustenance, and the small amount of money she is given cannot buy much in the weekly food markets, where prices have become inflated.

Abubakar was relocated to Alacha after reaching from Sudan in 2023, having run from the paramilitary Rapid Support Forces’ attack on her home city of El Geneina in June that year.

Finding no work in Chad, her partner has gone to Libya in the aspiration to gathering adequate cash for them to come later. She stays with his family members, sharing out whatever food they can get.

Abubakar says she has already witnessed food distributions being reduced and there are fears that the sudden reductions in international assistance funds by the US, UK and other European countries, could deteriorate conditions. Despite the war in Sudan having caused the 21st century’s gravest emergency and the {scale of needs|extent